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HomeMy Public PortalAbout6317 SALTER AVE_Electrical__ �j WORKERS'COMPENSATION DECLARATION '76A663 10/81 " APPLICATION FOIA dECTRICAL PERMIT c l hereby affirm that I have a certificate of consent to self CE e06G insure, ora certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES �� BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) f Policy No.CA 3&A%3 Company�ll�'TE FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS LOCALITY Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ 7 tion department. Multi-family Sq. Ft. CROSS ST.. — NEAREST �.,�� ,C��,�,�F L.VS� Residential Swimming Pools OWNER OR Date Applicant /� FIRM NAME ''I utem— CERTIFICATE OF EXEMPTION FROM WORKERS' •—�4K— MAIL Outlets: Rec Light Sw._ COMPENSATION INSURANCE First 20 1� 3 ADDRESS (This section need not be completed if the work Involved by Total No. CITY Tel. No the permit is for one hundred dollars($100)or less.) Additional 1G -Oo I certify that in the performance of the work for which this APPLICANT PLAK permit is issued, I shall not employ any person in any manner e so as to become subject to the Workers'Compensation Laws. Lighting Fixtures. First 20 '•i a ADDRESS I Total No._ Additional Date Applicant CITY Tel. No. NOTICE TO APPLICANT: If; after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range Heater_D.W. X APPLICANT Compensation provisions of the Labor Code, you must forth- Oven Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top FAU —W.H. — deemed revoked. Hood Fan _Other_ V CITYC�ntwTel. IVo. ^ Q' 11 LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions-of Chapter 9 Disp. Room Air Cond. REG.NUMBER J Class. ? (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCE ED BY and Professions Code,and m license is in full force and effect. Power Apparatus&Large Appliances Q. y ^ �� Size&Type HP, KW,.KVA, or KVAR' Q. �s ©� License'Number Lic. Class C.: INAL Up to 1 Inc[.Il 1 1�_�� Over 1 to 10 Incl. DATE �' —r VALIDATION Cd Contractor a e A Over 10 to 50 Incl.. FINAL I am exempt under Sec. t Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Date. Services, Swbd.,MCC&Panelboords 0%200 Amp. Under 600 V ' / `- Signature 201 -1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm-that I am exempt from the Contractor's License Additional Sign Branch Circuits C 4 11Law for the following reason (Section 7031.5, Business and Professions Code): I, as owner of the property, will do the work and the 1 Misc. Conduits&Conductors n 0 0 0 structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ _ , — C• r C 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for �, .! `0- (Sec. _ the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) �� (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE �D Lender's Address I certify that I have read this application and state that the TOTAL FEE r above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize esentatives of this ounty to enter upon the abo -me on property for tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature 0 Permittee Date WORKERS'COMPENSATION DECLARATIOA I' A[rL PCA Il OON FOR PLUMBING PERMIT .I keret y affirm that I have a certificate of consent to self 76A667q insure, or a certificate of'Workers'Compensation Insurance, I CE 817(REV..10/81) "—` C or a certified��c//opyy��thh�erre�eof(Sec. 3800, Lab. C'.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.41-M LCompany Sok Certified.copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS A/ �r tion department. NUMBER FIXTURE OR ITEM r� � FEE LOCALITY Date -` `r Applicant WATER.CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST: COMPENSATION INSURANCESHOWER OWNER ®� (This section need not be completed if the work involved by MAIL / the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS YO I certify that in the performance of the work for which this ap oU permit is issued, I shall not employ any person in any manner SINK CITY / � CT TEL. NO. ,�W-� so as'to become subject to the Workers Compensation Laws. p DISHWASHER o� i - F CONTRACTOR 7 i Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS �, r Exemption, you should become subject to the Workers'. SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the.Labor Code;.you must forth- LAWN SPRINKLER SYSTEM �f with comply with. such provisions or this permit shall be STATE �-t rt LIC* deemed revoked. WATER HEATER LICENSE NO. 1 i 3 C LICENSED.CONTRACTORS DECLARATION ;� �. DISTRICT NO P. ESSED$Y I hereby affirm that 1 am licensed under provisions of Chapter 9' GAS SYSTEM OUTLETS _ ��v(� (commencing with Section 7000)of Division 3 of the Business OUTLETS.OVER GGG and Professions Code;and my license is in ful.l.,force and effect. 5 PER SYSTEM FINAL q ` i VALIDATION dB 0 i2� DATE / ( (�f' U•License Number. Lic. Class 1B to IN �le �Sa �: FINAL Contractor �ft, BY ..t ' P6a ❑ 1 am exempt under Sec. j B.BP.C.for this reason Plan check fee ` 00 Date:. PLUMBING PERMIT ISSUING FEE$ ® b • Signature ,s� TOTAL FEE o[�. �0] %,Q 8_5 A Plan check applicant " 0 o o a o SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name a P 2 8 F 0 1 hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and , ce- S' Professions Code): City Tel. No, s '''�)G. ❑ 1, as owner of the property, will do the work and the o ! E 6;—4 4 structure is not intended or offered for sale (Section N 7044, Business and Professions Code.). , CONSTRUCTION.LENDING AGENCY I hereby affirm that there is a construction lending agency for . the performance of the work for which this permit is.issued (Sec. 3097, Civ. C.). , Lender's Name Lender's Address I certify that 1 have.read this application and state that the above information is correct. I agree to comply with all County ' ordinances and State laws regulating.Plumbing, and hereby authorize representatives of this County to enter upon -the above- en d.property f 'In ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date. Alf IA663-CEBOO 10-60 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARMENT OF COUNTY ENGINEER BUILDING / �? -BUILDING AND SAFETY DIVISION ADDRESS In J JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN,SUP'T OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CR ST. PERMIT'FEES OWNER Zug Iti P 1 T E M NUMSFERJ EACH I FEE. MAIL OUTLE / S $ ADDRESS LIGHTS RECEPT. , BW. (� .10 CITY TEL. NO. LIGHTING FIXTURES /ef .10 JA C) ELEC. RANGES CLO.DRYERS ELECTRICIAN 146X, (' WATER HEATERS .50 ADDRESS ELEC.SPACE HTRS DISHWASHERS `. CITY ! 2 TEL NO. GARBAGE DISPOSERS f AUTO.- �• STAT �✓ / WASHERS STA.COOKING UNITS / •25 LICENSE NO. J ���j ` MOTORS: OVER INC. H.P. DISiRIt G U ONE I P .ESSED Y 0— 1/2 .25 2 50 / NSPECTION RECORD 2— 5 1.00 /,7 / ! oy D'., 5_ 15 1.50 f �F�/� / 7 ! �} t - ": i!'7 U is— 5o 2.50 �� -Ve- \i .) �. fi: l�lP. � so— 200 5.00 ` L :r _ O 0 SIGNS: NO TRANS. 1� _ NO.LAMPS N SERVICE 0-600V 1.02 0 U z SERVICE OVER 600V 5.00' MISC. n t _ , WIRING PERMIT 1.00 U V FIXTURE PERMIT 1.00 D V SUPPLEMENTARY PERM IT iso TOTAL FEE S D I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION APPROVALS DATE/, I INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT I / /il WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 6 I/ ELECTRICAL WIRING. WIRINGHEREBY =f / I ' /1`1/l�� LICENSED AS REQUIRED EDABYI LOS ANGELES COUNTY AND STATE OF FIXTURES AM PROPERLY REGISTERED AND/011 I/ I/) 1 "Tr i,((/;I��)/ CALIFORNIA OR THAT 1 THE L OWNBR OF THE AND" • vs DESCRIBED RESIDENTIA PR PERTY POWER Ii w ! / 1 V SIGNATURE UTILITY CO.NOTIFIED _ �t :) )1.7'•', OF PERMITTE FINAL _ y=��4" L'�•- ! (DATION ART�IUR C.VEIT Mo CASH SUPERVISING ELECTRICAL ENGINEER I�6523 ;9 DED ?8 2 .0 12.3.0